Fertility after testicular cancer

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Dear OncoLink "Ask The Experts," I am a 23-year-old man who has been diagnosed with testicular cancer. I know I should be grateful for an opportunity to survive but I am stuck on wondering whether or not I can have kids after treatment. I need surgery and chemo...can you help?

David J Vaughn, MD, Medical Director of the Abramson Family Cancer Research Institute and Associate Professor of Medicine, Hematology-Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:

Fertility is an important issue in patients with testicular cancer. Some patients have lowered sperm counts related to the cancer itself, and some will experience fertility problems caused by the medical treatments for the testicular cancer. It is important patients discuss this issue with their oncologist.

About 30% of patients with testicular cancer (post-surgery) will have very low or no sperm as a result of the disease. If a person has adequate sperm counts prior to chemotherapy, at the immediate end of chemo all will have close to no sperm, but 80% will recover to pretreatment levels over 2-4 years. All patients should be offered the opportunity to sperm bank prior to chemotherapy or retroperitoneal lymph node dissection, which in some patients can result in dry ejaculation (unless chemotherapy needs to be emergently initiated and there is not time to sperm bank). Advances in reproductive technology have allowed men with post-chemotherapy non-obstructive azospermia (i.e., no sperm in semen but not because of obstruction) to undergo very complicated but successful extraction of sperm from the testicle, fertilization of the egg in a test tube, followed by implantation of the fertilized egg in a woman. However, this technology is not a substitute for sperm banking.

Mar 3, 2015 - The biopsy of testicular tissue from prepubescent boys with cancer for cryopreservation did not cause serious adverse after-effects and may someday offer a way to preserve fertility, according to a study published online Oct. 27 in Human Reproduction.